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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566206746
Report Date: 07/16/2019
Date Signed: 07/16/2019 04:30:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GUTIERREZ FAMILY CHILD CAREFACILITY NUMBER:
566206746
ADMINISTRATOR:MARIA GUTIERREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 336-9215
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:14CENSUS: 11DATE:
07/16/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Maria GutierrezTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Michael Avila made an unannounced visit for the purpose of conducting a Case Management visit. LPA Avila met with Licensee and discussed the nature and purpose of the visit.

On 3/10/19 at or around 2pm an children (C1 and C2) were observed in the doll house in the backyard. A parent came to pick up one of the children when the parent notice her child was nervous when she came to pick up her child. After taking her child home, the child disclosed that the other child in the doll house had kissed him on his cheek. The parent contacted Licensee and Licensee self-reported the incident to the Department and informed the parent of the other child.

During today's visit, LPA Avila interviewed of the children about the incident. Licensee informed LPA the doll house had been disassembled and removed from the backyard.

Based on the information obtained from both the interview with the child and with Licensee, LPA determined there were no deficiencies and that Licensee acted in accordance with Title 22 regulations.

A Technical Advisory has been issued for the following C.C.R., Div. 12, Title 22 Regulation: 102417 Operation of a Family Child Care Home.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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